International Urology and Nephrology最新文献

Purpose: To evaluate the impact of early surgical intervention on outcomes in patients admitted non-electively for macroscopic hematuria, a clinical scenario with limited prior research.

Methods: We conducted a single-center, retrospective observational study including 261 consecutive patients admitted non-electively with a primary diagnosis of macroscopic hematuria to the Urology Department at Hospital Universitario 12 de Octubre, Spain, between January 2016 and June 2021. Patients were stratified into three groups: no surgical intervention, surgical intervention within 5 days, and surgical intervention after 5 days. Baseline characteristics, 365-day readmissions, and mortality were analyzed using binary logistic regression, zero-inflated Poisson, and Cox proportional hazards models.

Results: The median age was 82 years and the median Charlson Comorbidity Index was 6. Crude 365-day readmission and mortality rates were 50.6% and 30.7%, respectively. Patients who underwent surgical intervention had lower 365-day mortality (hazard ratio [HR] 0.56, 95% confidence interval [CI] 0.32-0.97, p = 0.038) and readmission rates (odds ratio [OR] 0.28, 95% CI 0.15-0.54, p < 0.001). Significant risk factors for 365-day mortality included red blood cell transfusion (HR 2.12, 95% CI 1.29-3.49, p = 0.003), higher Charlson Comorbidity Index (HR 9.16, 95% CI 2.22-37.54, p = 0.002), and greater disease complexity (HR 2.35, 95% CI 1.63-3.39, p < 0.001). The single-center, retrospective design limits the generalizability of these findings.

Conclusions: In this cohort of elderly patients with substantial comorbidity, early surgical intervention, when clinically indicated, was associated with significantly reduced 365-day mortality and readmission rates.

Background: Kidney diseases, including both acute and chronic conditions, present significant global health challenges. Macrophages and endothelial cells play critical roles in the onset and progression of these diseases. This review aims to explore the bidirectional interactions between macrophages and endothelial cells and their roles in kidney diseases.

Method: By analyzing existing literature, this paper focuses on discussing the interaction mechanisms between macrophages and endothelial cells in acute kidney injury (AKI) and chronic kidney disease (CKD), including cytokine secretion, exosome transport, and adhesion molecule expression.

Result: Research demonstrates that macrophages regulate endothelial function and angiogenesis through cytokine release, exosome transfer, and adhesion molecules, while endothelial cells control macrophage recruitment and activation via adhesion molecules. These interactions are essential in balancing kidney injury and repair, as well as modulating inflammation and fibrosis.

Conclusion: The current research is mostly based on the animal models and has not fully addressed the issue of species-specific differences. Future research should combine multi-omics technology and patient-derived organoids to validate therapeutic targets and promote clinical translational research.

Purpose: To investigate the effects of fluoxetine on the levels of depression and anxiety in hemodialysis patients.

Methods: In this 8-week randomized double-blind placebo-controlled study, chronic hemodialysis patients who were 18 to 80 years old were assigned to receive a placebo or fluoxetine capsule. Of the 295 screened patients, 54 were diagnosed with major depressive disorder, and 31 were assigned into the fluoxetine or placebo group. Finally, 19 patients completed the trial. The severity of depression and anxiety were assessed biweekly via the Beck Depression Inventory-II (BDI-II) and the anxiety subscale of Hospital Anxiety and Depression Scale (HADS-A), respectively. The statistical package for the social sciences software, version 20 was used for data analysis. Generalized estimating equations (marginal model) were used to compare the changes in the BDI-II and HADS-A scores between the two groups.

Results: At the end of week 8, the BDI-II score in the fluoxetine group was significantly lower than that in the placebo group (β = -19.22, 95% CI -25.62 to -12.51, P < 0.001). However, the score of the HADS-A did not show a significant difference between the two groups (β = -4.24, 95% CI -16.19 to 7.71, P = 0.487). Ten patients reported side effects which were more common in the fluoxetine group.

Conclusions: Compared with placebo, fluoxetine significantly decreased the depression severity. However, this study did not show a significant effect of fluoxetine on the severity of anxiety. Larger, long-term studies are warranted to validate these findings.

Trial registration: The study protocol was registered on IRCT.ir (registration number: IRCT20220422054611N1) ( https://irct.behdasht.gov.ir/search/result?query=IRCT20220422054611N1 ), Registration date: 2022-05-27.

Purpose: To analyze and discuss the epidemiological characteristics and disease burden of acute glomerulonephritis in China from 1990 to 2021, predict its incidence in China from 2022 to 2036, and provide a reference for developing treatment and prevention strategies.

Methods: Data on acute glomerulonephritis in China were collected from the 2021 Global Burden of Disease database. The Joinpoint regression model was used to analyze the average annual percentage change and annual percentage change of age-standardized rates, years of life lost due to premature mortality, years lived with disability, and disability-adjusted life years. The age-period-cohort model was used to analyze the incidence from 1992 to 2021, and the Bayesian age-period-cohort method was used to predict the incidence from 2022 to 2036.

Results: Standardized incidence and mortality rates of acute glomerulonephritis in China showed a downward trend from 1990 to 2021, with average annual decreases of 4.157% and 3.861%, respectively. In 2021, the incidence and mortality rates were 7.70 (95% UI 6.55-9.01) and 0.31 (95% UI 0.21-0.40) per 100,000, respectively. The years of life lost, years lived with disability, and disability-adjusted life years also decreased. The age-period-cohort model indicated increased risk in the 0-14 and 80-99 age groups. The period effect showed a downward trend in risk from 1992 to 2021 but a slight increase since 2017. Birth cohort analysis revealed higher risks for some persons. By 2036, the male incidence may decrease to 7.38 per 100,000 while females may increase to 8.47 per 100,000.

Conclusion: We observed an overall decline in disease burden and risk. However, some age groups remain at risk. We also observed a slight increase since 2012. Future projections suggest rising female incidence. Targeted interventions for high-risk groups like children, adolescents, the elderly, and females are needed to reduce the disease burden.

Purpose: Carotid atherosclerosis is a major cardiovascular complication in patients with chronic kidney disease (CKD). The hemoglobin glycation index (HGI) has been linked to glycation stress and vascular inflammation, which may contribute to atherosclerosis. However, its relationship with carotid plaque in patients with CKD remains unclear. This study aimed to investigate the association between HGI and carotid plaques in non-dialysis CKD stage 3-5 patients.

Methods: This retrospective cross-sectional study included 195 non-dialysis CKD stage 3-5 patients. HGI was calculated as the difference between observed glycated hemoglobin (HbA1c) and predicted HbA1c, which was derived from fasting blood glucose. Carotid plaques were assessed via ultrasound. Multivariable logistic regression models were used to examine the association between HGI and carotid plaques, adjusting for cardiovascular risk factors (age, sex, body mass index, smoking, drinking, hypertension, cholesterol), CKD-related variables (estimated glomerular filtration rate, hemoglobin, intact parathyroid hormone) and medications (statins, sodium-glucose cotransporter-2 inhibitor, and glucagon-like peptide-1 receptor agonist). Restricted cubic spline (RCS) analysis was conducted to explore nonlinear relationships, and a threshold effect analysis was performed using piecewise logistic regression. Subgroup analyses were conducted to examine consistency across different subgroups. Causal mediation analysis was used to assess the potential mediating roles of age and diabetes mellitus.

Results: Among 195 non-dialysis CKD stage 3-5 patients, higher HGI was independently associated with carotid plaque (OR 1.76, 95% CI 1.09-2.98, P = 0.026). RCS analysis revealed a nonlinear relationship with a threshold at HGI = 0.2. Above this value, the risk of plaque increased significantly. ROC analysis showed modest discrimination (AUC = 0.64). Subgroup analysis confirmed the association in diabetic patients but not in non-diabetics. Mediation analysis indicated that age and diabetes explained 37.3% and 46.9% of the HGI-plaque association, respectively.

Conclusions: In non-dialysis CKD stage 3-5 patients, higher HGI was independently associated with the presence of carotid plaque, particularly among those with diabetes. These findings suggest that HGI may serve as a useful marker for vascular risk stratification in this high-risk population. However, its predictive value appeared limited in non-diabetic patients, indicating that the interpretation of HGI in this subgroup should be made with caution and warrants further investigation.

Purpose: Prostate biopsy is needed for diagnosing prostate cancer, the commonest cancer affecting men. Due to its lower rates of post-procedural infection compared to transrectal approaches, the use of transperineal approaches may increase. There is limited current evidence of serum biomarker changes following transperineal template prostate biopsy (TTPB) and their correlation with clinical outcomes.

Methods: A within-group, repeated-measures observational study was employed. Venous blood samples were taken pre-TTPB (baseline) and at 30 and 240 min post-TTPB in 6 patients (median age 67 years, age range 63-76). The serum concentrations of 13 selective human growth factors were measured using the Luminex® Performance Assay. Patient medical notes were reviewed to assess clinical outcomes.

Results: Following TTPB, significant increases were demonstrated in the serum concentration of PDGF-AA and TGF-alpha (p ≤ 0.05). Significant decreases were observed in the serum concentration of EGF and Flt3 ligand (p ≤ 0.05). There were no significant differences in the serum concentrations following TTPB in: CD40 Ligand, G-CSF, GRO-beta, IL-8, IL-33, MIP-3 beta, PDGF-AB/BB, TRAIL, and VEGF (p ≥ 0.05). There were no significant post-operative complications.

Conclusions: The significant increases in serum PDGF-AA and TGF-α, and significant decreases in serum EGF and Flt3 ligand could be explained by post-procedural inflammatory or paraneoplastic mechanisms. Further research into these biomarkers with larger cohorts may enable further understanding of their role pre- and post-operatively in TTPB and their correlation with clinical outcomes. This may be used to develop a clinical tool to predict or identify patients at risk of early post-TTPB complications.